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AP Psych—Ch. 14:
Psychological Disorders
(Abnormal Psychology)
Also known as “psychopathology”
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A Statistical Approach
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Norm = average, median
In statistics, normal = things
characteristic of the majority of
the group
The statistical approach doesn’t
differentiate between “desirable”
and “undesirable” behavior

For example, a statistical model assessing intelligence
would view both geniuses and mentally retarded people
as “abnormal” because they’re not characteristic of the
majority of society. In actuality, society does not refer to
geniuses as “abnormal” because we see intelligence as a
desirable trait.
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Criteria of Abnormal Behavior
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Deviance
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Behavior that deviates
from what society
considers acceptable
Culturally driven
Maladaptive Behavior

Interferes with social or
occupational functioning
Personal Distress
*Don’t need all 3 to have
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a disorder

Psychological Classification
A Medical Model
•making the assumption that mental
illness can be described in the same
manner as any physical illness.
•Diagnosis—distinguishing one illness
from another
•Etiology—cause & history of an illness
•Prognosis--Forecast about the probable
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course of an illness
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Diagnostic and Statistical
Manual of Mental Disorders
1952: American Psychological
Association agreed upon a
standard system for
classifying abnormal behavior
It has been revised five times
Most recent revision (DSM-V)
in May 2013
Previous revision: 1994
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Before the DSM
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The two most commonly diagnostic
distinctions were “neurosis” and “psychosis”
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Neurotics struggled with certain mental conditions, but still
remained connected with reality.
Psychotics referred to those who had lost touch with reality
“Neurotics build dream castles in the air, the psychotics
move in, and the psychiatrists collect the rent.”
These terms have been replaced but are
still used by many psychologists
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New Categories
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Anxiety disorders
Somatoform
disorders
Dissociative
disorders
Mood disorders
Schizophrenia
Personality
disorders
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Categories of Mental Disorders


Anxiety Disorders
 Generalized anxiety
disorder
 Phobic disorder
 Panic disorder
 Obsessive-Compulsive
disorder
 Post-traumatic stress
disorder
Somatoform Disorders
 Psychosomatice
disorder
 Somatoform disorder
 Conversion disorder
 Hypochondriasis
• Dissociative Disorders
• Dissociative amnesia
• Dissociative fugue
• Dissociative identity disorder
• Mood Disorders
• Depression
• Dysthymic disorder
• Bipolar disorder
• Cyclythymic disorder
• Schizophrenic Disorders
• Paranoid schizophrenia
• Catatonic schizophrenia
• Disorganized schizophrenia
• Undifferentiated schizophrenia
• Personality Disorders
• Antisocial personality disorder
• Other personality disorders
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DSM-IV
Descriptions
1.
2.
3.
4.
Essential features of the disorder
Associated features present
Information on differential diagnosis
Diagnostic criteria
*All so that it will reduce the chances that one doctor might
diagnose a patient as schizophrenic while another diagnoses
the same patient as bipolar.
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Axis 1: Clinical Syndromes
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Axis I disorders: first diagnosed in
infancy, childhood, adolescence
Attention deficit, brain damage,
substance abuse, schizophrenia,
moods, anxiety, somatoform,
dissociative, sexual, eating, sleep,
impulse control
What brings you in to see a doctor in
the first place
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Axis II: Developmental
Disorders/Personality/Mental Retardation
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Compulsiveness
Over-dependency
Aggressiveness
Language disorders, reading or
writing difficulties, autism, speech
problems
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Axis III: Physical Disorders
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General medical
conditions
Diabetes, arthritis,
hemophilia, etc…
Brain damage (e.g., a
tumor or aneurysm)
Chemical imbalances
*Physical problems that
could be causing Axis
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I/II disorders
Axis IV: Measurement
of Current Stress Level

life changes or events that cause
particular stress in a person’s life
and contribute to illness and
pathology
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Death of a spouse
Loss of a job
Based on stress in the last year
(Holmes & Rahe SRRS)
Stress contributes to 80% of all
diseases
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Axis V: Adaptive Functioning
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Social relations
Occupational functioning
Use of leisure time
“Global Assessment of Functioning”
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Anxiety Disorders:
Characteristics
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Excessive fear or dread in
response to a real or
imagined danger
Out of proportion to the
situation
Worry, mood swings,
headaches, weakness,
sweating, fatigue, feeling
that one is in danger
17% of the population
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Types of Anxiety
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Generalized anxiety
disorder (GAD)
Phobic disorder
Panic disorder
Obsessive-compulsive
disorder (OCD)
Post-traumatic stress
disorder (PTSD)
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Generalized
Anxiety Disorder
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Chronic, high level of anxiety
that is not tied to any specific
threat
Panic attacks (chest pain,
choking, trembling, diarrhea,
reduced appetite,
indigestion)—but not all the
time
Can’t make decisions, trouble
with family
Physical complaints
May be genetic; arises
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following major life changes
Phobic Disorders
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Severe anxiety
about a
particular
object, animal,
activity, or
situation
Types:
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
specific
Social
(agoraphobia)
See pg. 578
http://www.phobialist.com/
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Panic Disorders
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A feeling of sudden,
helpless terror
A sense of impending
doom or death
Smothering, choking,
faintness, difficulty
breathing, nausea,
chest pain
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Obsessive-Compulsive Disorder
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Obsession:
thinking the same
thoughts over and
over again
Compulsion:
performing
irrational acts
May have a
genetic basis
Video Clip—20 year old
girl w/OCD
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Post-Traumatic
Stress Disorder (PTSD)
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NPR audio article: Ending
Nightmares Caused by PTSD
After a traumatic event,
severe, long-lasting effects
Flashbacks, night-mares or
night terrors, anxiety,
insomnia
Combat vets, victims of
rape or assault, survivors of
disasters
Combat veterans,
rape/assault victims,
disaster survivors
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Etiology (cause) of Anxiety Disorders
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Biological Factors
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concordance rate (% of twin pairs with the same disorder)—
slight genetic similarity; anxiety sensitivity—some people are
more sensitive to the internal physiological symptoms of
anxiety & then overreact with fear
Conditioning and Learning
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Classical—traumatic experience made a neutral stimulus a
conditioned stimulus
Operant—avoiding what you’re scared of-negative
reinforcement
Evolutionary—historical threats (bugs/snakes) vs. modern
threats (irons/outlets)
Observational—watching how parents respond to threats…
Etiology (cause) of Anxiety Disorders (cont’d)
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Cognitive Factors
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Focusing too much attention on perceived threats
Misinterpreting harmless situations as threatening
Selectively recall information that seems threatening
(The doctor examined little Emma’s growth)
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Personality
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Neuroticism (people who are self-conscious, nervous,
jittery, insecure, guilt-probe, & gloomy)
Stress
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Positive correlation between high stress & anxiety
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Psychosomatic and Somatoform
Disorders
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Psychosomatic disorders:
involve real, identifiable
physical illnesses; caused by
stress or anxiety
Somatoform disorders:
symptoms appear that are
not characteristic of any
readily identifiable disease;
no organic cause
Two types of somatoform
disorders: conversion
disorder, hypochondriasis
Conversion
Disorder
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occurs when a person “converts” psychological
and/or emotional distress into physical symptoms,
usually to avoid dealing with a painful or stressful
situation in their lives
Conversion of emotional difficulties into the
loss of a specific body function
rare and involve severe physical problems such as
paralysis, numbness, seizures, blindness, and
deafness
No physical damage
Because conversion disorders offer a way to avoid
stress and pain, sufferers often accept their physical
problems with relative calm, remaining
unconcerned or even cheerful about their condition.
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Conversion Disorder
(examples)
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Glove anesthesia
Sufferers experience a complete lack of
feeling from the wrist down, retaining
sensation in the rest of the arm
anatomically impossible: the nerves of the
hand and arm blend together, so if a person
really had nerve damage affecting their
hand, it would affect their arm as well.
Another type of conversion disorder
involves paralysis of the legs; however, the
sufferer is sometimes seen sleepwalking at
night.
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Hypochondriasis
People with hypochondriasis interpret any
small physical ailment they have (such as
minor aches, bumps, or bruises) as a sign of a
serious illness.
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Looks for signs of
serious illness
Found most often
in young adults
Occurs equally in
men and women
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Etiology of Somatoform Disorders
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Highly active autonomic system?
Personality Factors (especially histrionic
personalities—self-centered, suggestible,
excitable, highly emotional, overly dramatic)
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Cognitive Factors (good health=complete
absence of symptoms and
discomfortunrealistic)
The Sick Role

Indirect benefits like avoiding everyday
challenges, having an excuse for failure,
people demand less from you, attention from
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others
Dissociative Disorders
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A person experiences alterations in
memory, identity, or consciousness
Includes amnesia and multiple
personalities
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Dissociative Amnesia
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Memory loss with no biological
explanation (form of selective
forgetting)
Blotting out painful experiences &
repressing it to into their
unconscious
Total amnesia is very rare
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Dissociative Fugue
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Amnesia coupled with active flight
May establish a new identity
Repression of past knowledge
May last from days to decades
“Traveling amnesia”
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Dissociative Identity Disorder
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Multiple personalities
(two or more distinct
identities, each with their
own way of thinking and
behaving)
usually relates to severe
physical or sexual abuse
suffered as a child
Different personalities in
control at different times
Case studies
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Etiology of Dissociative Disorders
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Excessive stress
Severe emotional trauma?
Certain personality traits
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Fantasy-proneness
Some think it is intentional roleplaying to avoid personal failings
Mostly unknown because of its rarity
Only about 25% of American
psychiatrists believe in DID (1999)
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Schizophrenia
and Mood Disorders
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“Schizophrenia” = “split mind”
Schizophrenia--severe disorder that involves disordered
thoughts, extreme emotions that have nothing to do
with any particular situation, and very strange behavior
Mood disorders--person experiences unusual,
prolonged changes in their mood or emotions. The most
common mood disorders are depression and mania.
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Depression--overwhelming feelings of despair, sadness, and
hopelessness, a severe drop in self-esteem, leading to feelings
of worthlessness and self-hatred
Mania--opposite of depression: afflicted people feel
incredibly happy (bordering on euphoric), energetic, and
gregarious
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What Is Schizophrenia?
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Distortion/disturbance of
cognition, emotions,
perception, and motor
functions
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Can lead to brain damage
Confused, disordered
thoughts
Affects 1 in 100
Odds increase 1 to 10 if it
runs in the family
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Schizophrenia (cont.)
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Loss of contact with reality
Lives life in an unreal dream
world
Delusions, disembodied voices,
& vivid hallucinations
No single cause or cure
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Psychotropic drugs can help block
out the schizophrenic voices
Collection of symptoms
“Rule of Thirds”—1/3 gets
better, 1/3 stays the same, 1/3
gets worse
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Symptoms of Schizophrenia
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Delusions/paranoia
Hallucinations (visual or auditory)
Incoherent or marked decline in thought
Language changes
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Speech sounds like gibberish & unrelated words
thrown together
Inappropriate Affect (emotion
Sluggish emotions
Movement changes
Diverted attention (cognitive “flooding” that
erodes their ability to focus)
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Types of Schizophrenia
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Paranoid
Catatonic
Disorganized
Undifferentiated
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Paranoid Schizophrenia
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Complex delusions
Perceived persecution
Hallucinations of smell, taste,
other bodily sensations
Usually NOT visual
hallucinations
Unseen voices that give them
commands
Belief that they have a special
mission
Jani
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Catatonic Schizophrenia
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moves back and forth between a
waking state in which they often
become quite active and even
agitated, and a catatonic state
Catatonic state: mute,
immobile, mostly
unresponsive
“Waxy flexibility”
Unusual postures held for
long periods of time
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Disorganized Schizophrenia
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Disturbed and
Incoherent
language
Inappropriate
emotions
Disorganized
motor behavior
Hallucinations
(visions) and
delusions
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Undifferentiated Schizophrenia
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Deterioration of daily functioning
Hallucinations and delusions
Inappropriate emotions
Thought disorder
Doesn’t fit the other 3 types, but
has symptoms from them
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Remission
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No cure exists for schizophrenia, but some
sufferers do have periods where their
symptoms become greatly reduced or
disappear completely. Psychologists refer to
this as “remission” because symptoms almost
always return eventually.
Symptoms are completely gone or
still exist but are not severe enough
to have earned a diagnosis of
schizophrenia in the first place
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Etiology of Schizophrenia
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Genetic
Biochemistry/brain structure
Environment
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Genetics and Schizophrenia
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1% chance in general population
10% chance if it runs in the family
Adoption model studies
 One study looked at schizophrenic mothers who gave
birth to twins, one was given up for adoption. Even
though the twins grew up in different environments,
about 16% of them went on to develop schizophrenia.

Not conclusive
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Biochemistry/Brain Structure
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Psychosis results from chemical imbalances in the
brain
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Brain abnormalities
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Creates chemical imbalances
Stress
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may knock the brain’s mechanisms for processing information out of kilter
and interfere with normal synaptic transmission.
Creates biochemical changes
May not cause schiz but can contribute to its development
The dopamine hypothesis
 schizophrenia results from an excess of the neurotransmitter
dopamine at certain synapses
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CAT Scans and MRIs
Brains of identical
schizophrenic
twin has enlarged
ventricles. When
these ventricles fill
with fluid, they
enlarge and reduce
the space available
for brain tissue.
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Neurodevelopmental Hypothesis
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Schiz may be caused by insults or
disruptions in the normal maturational
processes of the brain before birth, causing
subtle neurological damage that elevates
vulnerability to schiz later on
Insults=viral infections or malnutrition
during prenatal development or obstetrical
complications during birth
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Family Experiences/Interactions
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Bad experiences during childhood are
not enough to lead to schizophrenia
Pathogenic (unhealthy family may
contribute to problems)—High
expressed emotion (EE)
Diathesis-stress hypothesis

although an individual may have inherited a
predisposition toward schizophrenia, the person must
be exposed to certain environmental stressors for it to
develop.
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Mood Disorders
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Seasonal
Affective Disorder (SAD)
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A type of depression
Affects people in most northern areas of the world
Less light available in winter = more melatonin
secreted by the pineal gland
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Melatonin regulates sleep cycle and has been linked to mood and
depression
Less daylight also seems to affect neurotransmitters that regulate the body’s
internal clock, including norepinephrine, serotonin, and dopamine.
Treatments: temporary sleep deprivation (to reset
biological clock), exposure to artificial light
Usually as winter begins to end and the days start to get
longer, the depression seems to lift and eventually
disappear.
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Suicide
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Every year, more than 32,000 Americans end their own lives.
One suicide occurs every 16 minutes.
Escape from physical or emotional pain, terminal illness or
loneliness, old age
Women attempt suicide more often than men, but men are more
likely to succeed.
occurs more commonly among the elderly and college students
(2nd leading cause of death among college students)
Desire to end “unacceptable” feelings (especially sexual feelings)
Attempt to “punish” loved ones who they feel should have
perceived and attended to their needs
70% of those who threaten suicide kill themselves within 3months
of making the threat.
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Kurt Cobain
Even people who seemingly “have
it all” commit suicide sometimes.
Musician Kurt Cobain’s band
Nirvana was at the top of the charts
when he killed himself with a
shotgun. He left behind a note: one
sentence in it stated, “I’m too much
of an erratic, moody baby! I don’t
have the passion any more and so
remember, it’s better to burn out
than to fade away.”
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Major Depressive Disorders
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Severe forms of depression that interfere with
functioning and concentration
Symptoms: lack of appetite, insomnia, and noticeable
weight changes (either an increase or decrease).
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Effects: hopelessness, suicidal impulses, feeling of
worthlessness
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Bipolar Disorder (formerly “manic depression”)
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Sufferers alternate
between despair and
mania
Manic phase: elation,
confusion. (Sometimes this phase
gets mistaken for a spurt of creativity. )
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Depressive phase: same
as for people with major
depression
Length of phases varies
from person to person
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Etiology of Mood Disorders
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Genetic vulnerability
Neurochemical factors
Cognitive factors (learned
helplessness)
Stress
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Genetic Vulnerability (Mood disorders)
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Genetics plays a strong role
High concordance rate
Heredity creates a predisposition to
mood disorders, but environmental
conditions convert it to a disorder
Genetics may play a higher role in men
than women
Genetics may be a bigger factor in
bipolar disorder than unipolar disorders
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Neurochemical factors
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Correlation between mood disorders
and the activity of norepinephrine
and serotonin
Decreased NE=depression
Increased NE=mania
Unbalanced levels of serotonin
No simple neurochemical
explanation…complex alterations in
neurotransmitter activity
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Cognitive Factors

Martin Seligman”Learned Helplessness
Model”
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Learned helplessness=passive “giving up”
behavior produced by exposure to
unavoidable aversive events (like
uncontrollable shocks in a lab)
Roots of depression lie in how people explain
the setbacks & other negative events they
experience
People with a “pessimistic explanatory style”
are more vulnerable to depression (glass is
half empty) (blame personal flaws instead of
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situational factors)
Hopelessness Theory
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Pessimistic explanatory style + high
stress + low self esteem =
hopelessness which = depression
Susan Nolen-Hoeksema—people
who ruminate about their
depression stay depressed longer
than people who try to distract
themselves
Negative thinking is what leads to
depression
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Interpersonal Roots
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Correlation between poor social
skills and depression
Depressed people are ….depressing,
so people tend to want to be around
them less and they end up with
fewer sources of social support
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Stress and Mood Disorders
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Moderately high link between stress
and the onset of mood disorders
Stress affects how people respond
to treatment and likelihood of a
relapse
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Personality Disorders
• People with personality disorders do not suffer from
anxiety, nor do they usually behave in bizarre ways.
• Instead, they are unable to establish meaningful
relationships.
• wide range of self-defeating patterns and behaviors, from
being painfully shy to acting vain and pushy.
• displays an inflexible, long-standing, and maladaptive way
of dealing with other people.
Ted Bundy--murdered at least 37 young women all across the nation. He
was well-educated, articulate, and charming. Even while sitting on death
row, he never showed any remorse for his crimes. Some psychologists
believed that Bundy had a personality disorder that prevented him from
establishing a normal, intimate relationship with a woman. When combined
with his intelligence, his amoral nature, and his lack of a conscious, it
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produced a deadly, pathological mix.
Types of Personality Disorders
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Anxious/fearful Cluster—Maladaptive efforts to
control anxiety and fear about social rejection
(maladaptive=adapting poorly)
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Avoidant Personality Disorder
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Dependent Personality Disorder
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Sensitivity to potential rejection, humiliation or shame
Socially withdrawn in spite of desire for acceptance
from others
Excessive lack of self-reliance & self-esteem
Needs others to make decisions
Constantly putting others’ needs above their own
Obsessive-Compulsive Personality Disorder
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Preoccupied with organization, rules, schedules, lists
Extremely conventional, serious & formal
66
Odd/Eccentric Cluster
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Distrustful, socially aloof and unable to connect with
others emotionally
Schizoid Personality Disorder
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Schizotypal Personality Disorder
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Cannot form social relationships
Absence of warm & tender feelings for others
Social deficits
Oddities of thinking, perception & communication
Mild form of schizophrenia
Paranoid Personality Disorder
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Pervasive & unwarranted suspicious & mistrust of people
Overly sensitive
Prone to jealousy
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Dramatic/Impulsive Cluster
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Overdramatizing personalities
Histrionic Personality Disorder
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Narcissistic Personality Disorder
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Grandiosely self-important
Preoccupied with success fantasies
Expect special treatment
No interpersonal empathy
Borderline Personality Disorder
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Overly dramatic
Exaggerated expressions of emotion
Egocentric, seeking attention, provocative dressing
Unstable in self-image, mood, and interpersonal relationships
Impulsive & unpredictable
Antisocial Personality Disorder
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Antisocial Personality
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serial killer Jeffrey Dahmer
Exhibits a persistent disregard for and violation of
others rights
Shallow emotions; don’t think about consequences of
their actions
Lacks a conscience, lives for the moment
Serial killers
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Many have antisocial personalities
Many abuse alcohol or drugs
Most were abused—emotionally, physically, and often
sexually—as children. (Abuse only served as a
contributing factor.)
Some serial killers believe that they are doing
something good for the society by killing certain types of
people.
According to psychologist Joel Norris, almost a third of
69
serial killers cannibalize their victims.
Reasons for Antisocial Behavior
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Imitation of one’s own antisocial
parents
Lack of discipline or inconsistent
discipline
Faulty nervous system; genetic
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Psychological
Disorders and the Law

M’naghten Rule
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Daniel McNaghten
Woodworker in 19th century Scotland
Had delusions and paranoid schizophrenia
Thought he was the target of a conspiracy
involving the Pope and British Prime Minister
Robert Peel
1843-tried to assassinate Peel but killed his
secretary instead
“delusional” so acquitted by rule of insanity
Public outrage, but it became a law the next
year
The Insanity Defense
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Involuntary Commitment
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Danger to
self
Danger to
others
In need of
treatment
72
Therapy and Change
73
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The Nature of Psychotherapy
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“Healing of the soul”
The term “mental illness” has outlived its
usefulness; mental stigma associated with that
phrase
Thomas Szaz--alternate view of abnormal
behavior, portraying it not as an illness but
merely as a deviation from society’s normative
structure


characterized mental illness as a form of cultural myth
and that people labeled as mentally ill simply have
problems coping in society
75
“problems in living”
Functions of Psychotherapy

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Learning to be
responsible for one’s
behavior
Take control of one’s life
Understanding how
one’s current way of
living can cause
problems; believe
change is possible
Therapist acts as a
guide
76
Main Kinds of Therapy






Psychoanalysis
Humanistic approach
Cognitive approach
Behavioral approach
Biological approach
Eclectic approach
77
Types of Therapists






Clinical psychologists
(Ph.D)
Counseling psychologists
(MA)
Clinical
neuropsychologists (Ph.D)
Psychiatrists (medical
doctor)
Psychoanalysts (Freudian)
Social workers, nurses
78
Common Methods Used….






Discussion
Advice
Emotional
Support
Persuasion
Advice
Relaxation
training




Role Playing
Drug therapy
Biofeedback
Group therapy
79
What Are the Qualities of a
Good Therapist?



Empathy &
understanding
Psychologically
healthy
Must be able to
create a
comfortable, safe
atmosphere
80
Group Therapy


Patients work together
with the aid of a
leader/therapist to
resolve interpersonal
problems
Advantages


Cheaper than one-onone therapy
Helps with high patientto-staff ratios in mental
hospitals
81
Family Therapy




Observes
interactions
Establishes an
objective point of
view
Identifies patterns
that lead to
problems
Helps untangle the
web of
communication
82
Self-Help Groups

People who share a
particular problem
(like alcoholism, cancer
survivors, abuse
survivors, parents of
terminally ill, or drug
addictions)


Conducted without
a professional
AA, ALANON,
ALATEEN

(12 step model)
83
Does Psychotherapy Work?



Hans Eysenck (1952): psychotherapy is no
more effective than no therapy at all (2/3
of people get better within two years w/o
therapy)
Allen Bergin (1971): challenged Eysenck’s
methodology (most people make at least
moderate improvements)
Smith & Glass (1977): meta-analysis
(combining results of a number of studies
and analyzing them) also disagreed with
Eysenck; some therapy is better than
none; most forms of therapy have similar
rates of effectiveness
84
Insight Therapies (“talk therapy”)



Originally based on the
tradition of Freud’s
psychoanalysis
Complex verbal
interactions intended to
enhance clients’ selfknowledge and promote
healthful changes in
personality and behavior
Individual or groups
(includes family & marital
therapy)
85
What Is Psychoanalysis?




Insight therapy
Developed by Freud
based on the theory that
psychological problems
result from anxiety about
feelings and thoughts a
person has repressed into
their unconscious
Therapy aimed at making
patients aware of their
unconscious motives so
they can gain control of
their lives
86
Free Association






A method used to examine the unconscious
Patients say whatever comes into their mind
Patients are strongly encouraged not to “edit”
themselves so that they can achieve a true “stream of
consciousness.”
psychiatrist often says nothing for long periods of time
Resistance (reluctant to reveal painful or embarrassing
things)
Slow process (years)
87
Transference




Sooner or later, the patient reaches a
level of comfort with their analyst.
A process in which patients take feelings
toward some other person and transfer
these feelings to the analyst
 (feelings for parents toward analyst)
Transference can be either positive or
negative: patients can feel good about
their analysts or they can take out their
negative feelings on them
the therapist does not take anything the
patient says personally, remaining
neutral
88
Humanistic/Client-Centered
Therapy





Insight therapy
Focuses on a person’s value, dignity,
worth
Reflects the belief that the client and
therapist are partners
Supportive emotional climate
The client plays a major role in
determining the pace & direction of
therapy
89
Client-Centered Therapy
(CCT)

Carl Rogers




believed the term “patient” suggests inferiority, while the term
“client” implies an equal relationship
Therapist shows real caring and empathy; assumes
people are basically good
Need to become self-actualized
Unconditional positive regard/empathy
(respect and empathy no matter what they might say)

techniques often involved repeating much of what he
would hear from his clients in order to help them clarify
their feelings.
90
Cognitive Therapy




Goal is to change the way people
think
It assumes that negative and/or incorrect
beliefs, expectations, and ways of thinking
can distort behavior.
helps people modify their behavior by
changing misconceptions they have about
themselves and society in general.
Behavior modification: a systematic
method for changing the way a
91
person acts and feels
Cognitive Therapies: Similarities
All types of cognitive therapy operate under the
same basic principles.
 Disconfirmation-- confronting patients with
specific evidence that directly contradicts their
existing beliefs
 Reconceptualization-- process in which the
therapist helps patients develop an alternative
belief system to explain their experiences and
observations.
 Insight-- clients work toward an understanding
92
of how they arrived at these new beliefs.
Rational-Emotive
Therapy (RET)

Albert Ellis aimed at changing unrealistic
assumptions (“everything I do must be approved by others” or
“I need to be loved by everybody.” )



People behave in rational ways
Role playing


Wanted to correct these false & self-defeating beliefs
For example, if a client believed he would never have any success with
women, Ellis would have him practice his skills at asking for a date. He
would then direct the patient to ask out women whom the patient believed
would be likely to reject him. This experience would help the client learn
that he can cope with things not going his way.
May be called REBT (Rational-Emotive
Behavioral Therapy)
93
Ellis’s A B C
Ellis claimed that experiences by themselves don’t cause psychological problems;
rather, it is the way a person thinks about the experience that leads to troubles. In
other words A does not cause C, rather B causes C.
94
Aaron Beck’s Cognitive
Therapy


Maladaptive thought patterns cause a distorted
view of oneself and lead to problems
Therapists use persuasion and logic to try to help patients
change existing beliefs.


For example, if a client believes that he or she never has a good time, the therapist
might point out that this is a hypothesis, not a fact. The therapist might then ask the
client to test the hypothesis by looking at the evidence differently, and note the times in
their lives when they did in fact have a good time.
Works well with depressed people

Beck theorized that depressed people blame themselves for their problems rather than
their circumstances. He also believed that depressed people focus on only negative
events and ignore positive events, which leads them to make pessimistic projections
about the future and undermine their self-esteem and sense of worth.
95
Behavioral Therapies

Changing undesirable behavior through
conditioning.



assumes that people become disturbed because they
have learned to behave in an undesirable way and that
any behavior learned can also be unlearned
Don’t spend time going over the past
Focus on producing a change in
behavior; thoughts will follow
96
Systematic Desensitization




A technique used to help a
patient overcome irrational
fears and anxieties
Pairs relaxation techniques
with anxiety-producing
situations
Pic of snake  touching a
snake
Counter-conditioning
97
Counter-conditioning
1. The person builds an “anxiety hierarchy,”
with the least feared situation at the bottom
and the most feared at the top.
2. The person practices deep muscle relaxation
techniques.
3. Eventually, the person learns to use these
relaxation techniques to cope with each
situation in the hierarchy.
98
Flooding
• Directly exposing a
patient to the object or
situation they fear.
•If scared of water, the
therapist would have the
hydrophobic patient wade
out a little deeper each
time (usually the therapist
would accompany them).
99
Modeling
Patients and therapists first analyze
anxiety-arousing situations step by
step. The therapist then gradually
exposes the patient to real-life
situations and models (demonstrates)
the desired behavior.
100
Aversive Conditioning



Links an unpleasant state with an
unwanted behavior in an attempt to
eliminate the behavior
Use of drugs with alcohol that cause
nausea (dysulfurum)
50% success rate; takes 6 months
101
Operant Conditioning



Behavior that is reinforced tends to
be repeated
Contingency management:
undesirable behavior is not
reinforced, while desirable behavior
is reinforced
Used in prisons and mental
hospitals
102
Token Economies


Desirable behavior is reinforced
with valueless objects or points
which can be accumulated and
exchanged for various rewards
Use of “hospital or token money”
103
Cognitive Behavior

Based on a combination of
substituting healthy thoughts for
negative thoughts
focuses on setting goals and
changing the client’s
interpretation of their situation
designed to help clients
differentiate between serious,
real-life problems and imagined
or distorted ones

104
Biological Therapy




Assumes an underlying
physiological problem
Medication, electric shock (ECT),
psychosurgery
Must be administered by a
psychiatrist
Used when talking and learning
theories do not work
105
Drug Therapy


Psychopharmacotherapy
Drug therapy tries to help patients by manipulating
levels of neurotransmitters in the brain



tries to help patients by manipulating levels of
neurotransmitters in the brain
For example, one theory of schizophrenia postulates that people
develop the disease when their dopamine receptors become
overactive.
Three major groups



Antipsychotic drugs
Antidepressant drugs
Antianxiety drugs
106
Antipsychotic Drugs



Treating schizophrenia
AKA Neuroleptics
Examples:
 Thorazine &Haldol: blocks or reduces
the sensitivity of the dopamine receptors

Clozapine: decreases dopamine levels
while simultaneously increasing serotonin levels


Decrease activity at the dopamine
synapses
Side effect: Tardive Dyskinesia

muscle rigidity, tremors, and coordination
problems.
Antidepressants




works on neurotransmitter levels and
are used to treat anxiety, phobias, and
obsessive compulsive disorder (OCD).
MAO inhibitors (MAOIs),
tricyclics
SSRIs (Selective Serotonin
Reuptake Inhibitor)
 Can also treat OCD & Panic
disorders
Increase the amount
monoamines, norepinephrine, or
serotonin
SSRI’s—usually have less size
Some
affects (Prozac, Paxil, Zoloft,
antidepressants also
Wellbutrin)
used for anxiety.
108
Lithium Carbonate

Lithium is a naturally
occurring salt that controls
levels of norepinephrine

A chemical used to treat mood
swings or bipolar disorder
Very dangerous side effects



Acute toxicity
sometimes used to treat
severely depressed and suicidal
people
109
Anti-Anxiety Drugs


Benzodiazepines (Tranquilizers
like Valium, Xanax)
Relieve anxiety and panic
disorders by depressing the
activity of the CNS



Makes you drowsy
More mild than other drug
therapies
Lethal when mixed with alcohol
110
Electroconvulsive Therapy (ECT)
• Used mostly for severe
depression
• The shock is intended to induce a
convulsion in the brain similar to an
epileptic seizure (70-150 volts for 0.1-1
seconds)
• Now, there is rTMS (repetitive
transcranial magnetic stimulation)
111
Psychosurgery


Destroys part of the brain to make the patient calmer and freer of
symptoms
Pre-frontal lobotomy (a radical procedure that cuts off parts of the
frontal lobes of the brain)



1950’s—used for Schizophrenia, depression,
bipolar, OCD
lobotomies would often sever the frontal lobes from
the rest of the brain, either by boring a hole in the
patient’s skull or by passing an electric needle
through the edge of the eye socket and cauterizing
the brain tissue.
caused a great amount of damage to intellectual
functioning, and the procedure is no longer used. 112
Eclecticism

Using two or more systems of
therapy
113
The Deinstitutionalized Person
• Transferring the treatment of
mental illness from inpatient
institutions to community-based
facilities that emphasize outpatient
care
• Revolving door
• Homelessness
114